Treatment issues in type 1 diabetes.

Abstract

This is the third in a series of reports on the American Diabetes Association (ADA) 61st Scientific Sessions held in Philadelphia, PA, in June 2001. It covers topics related to the treatment of type 1 diabetes. In a symposium at the ADA meeting, Charles M. Peterson, Bethesda, MD, gave an overview of noninvasive glucose monitoring, stressing the need to critically evaluate the differing technologies. Since 1995 there have been 8 new drugs, 8 new insulins, and 35 new meters introduced on the market; glucose monitoring is a huge industry that is growing by 15% annually. Peterson asked why there is no noninvasive meter, and answered, “because it’s so difficult!” Wet chemistry, solid-phase reagent chemistry, and electrochemical sensing all require a sample as well as a reagent and therefore are “invasive.” Three general approaches exist for glucose enzyme electrodes, measuring O2 consumption, or measuring H2O2 production, with potential cross reactions from metals and ingested drugs. The latest approach has used a two-step enzymatic reaction in which glucose oxidase reduced by glucose is regenerated to its original form for further sample processing. Problems include sample size and preparation, complicated electronics and processing, response time versus sensitivity, sensor fouling, and effects of oxygen and oxidizing interfering substances, including ascorbic acid, uric acid, and acetaminophen. Humidity effects, stability, precision, accuracy, and membrane issues when the substrate is partitioned into a different compartment are additional factors to be addressed. Satish K. Garg, Barbara Davis Center, Denver, CO, discussed clinical applications of continuous glucose monitoring, which can overcome the discomfort of multiple fingerstick glucose measurements and allow assessment of the peaks and valleys of glucose levels in patients with diabetes. He noted an important discrepancy between the conventionally treated and intensively treated groups in the Diabetes Control and Complications Trial (DCCT), so …